Debate continues over the effectiveness of screening by mammography in women below age 50. We report here on results of screening in the first 10 years of a randomised trial to study the effect on breast cancer mortality of invitation to annual mammography from age 40 to 41 compared to first invitation to the 3-yearly UK national programme at age 50 -52. The trial is taking place in 23 NHS breast screening centres. Between 1991 and 1997, 160 921 women were randomised in the ratio 1 : 2 to intervention and control arms. Screening is by two views at first screen and single view subsequently; data on screening up to and including round five are now complete. Uptake of invitation to screening is between 68 and 70% at all but the latest screening rounds. Rates of referral for assessment are 4.6% at first screen and 3.4% at subsequent screens. Invasive cancer detection rates are 0.09% at first screen, and similar at rescreens until the sixth and later screens. There is little evidence of regular mammography in the trial control arm. The setting of this trial within the NHS breast screening programme should ensure applicability of results to a national programme.

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Baby Check is a systematic way of grading the severity of illness in infants. We studied its usefulness for assessing 53 infants presenting to a clinic in a West African village. Their ages ranged from 2 weeks to 7 months. The Baby Check scores ranged from 0 to 30. Forty-four infants were considered by the doctors to be well or mildly ill, 41 of these had scores below 9. The three infants with higher scores had symptoms and signs suggesting they were more than mildly ill. Nine infants were considered to be moderately ill. Their scores ranged from 4 to 30. The babies with the low scores had few symptoms and diagnoses suggesting they were only mildly ill. The babies with the highest scores all had diagnoses requiring medical attention. This pilot study of Baby Check in a developing country suggests that its use by health workers could increase the accuracy with which babies are referred for a medical opinion, and be a valuable tool for the identification of such infants in a busy clinic.

The UK Age Trial of mammographic screening from age 40 has reported a nonsignificant 17% reduction in breast cancer mortality calculated on an "intention to treat" basis. High levels of ad hoc screening in the control arm could potentially have diluted the estimated effect. Objectives: To estimate the level of unscheduled mammography in the control arm of the UK Age Trial. Methods: Data were obtained from questionnaires sent to a random sample of 3,706 women at five centers in the control arm of this trial. Questions included in the Office for National Statistics Omnibus Surveys about the timing of and reasons for any breast screening provided comparable data. The overall response rate was 58.8%.Results: Overall, 24.9% (95% confidence interval, 23.0-26.8) of Age Trial controls responding reported ever having had a mammogram, 18.2% reported a mammogram for symptomatic reasons, and 8.4% reported unscheduled mammography. Overall, 4.0% and 1.8% of women reported symptomatic and unscheduled mammography, respectively, within the previous 12 months. Results from the Omnibus surveys were similar, 14.2% of women reported previous mammography for symptomatic reasons or follow-up after breast cancer and 6.8% reported unscheduled mammography.Conclusions: The level of contamination due to mammographic screening in the control arm of the Age Trial was low and will have had a minimal effect on the estimated reduction in mortality from breast cancer.

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